The Association of Family Support After Childbirth With Posttraumatic Stress Disorder in Women With Preeclampsia

Psychological interventions to pregnancy-related complications in patients with post-traumatic stress disorder: a scoping review

OBJECTIVE

This scoping review sought to investigate the association between pregnancy-related complications and post-traumatic stress disorder (PTSD) among postpartum women, then summarize effective psychological interventions for pregnancy-related PTSD or sub-PTSD.

METHOD

Publications in English and Chinese were searched in PubMed, Embase, Cochrane, ISI Web of Science, China National Knowledge Infrastructure (CNKI), and WanFang databases using the subject headings of "Stress Disorders, Post-Traumatic", "Pregnant Women", and "psychotherapy". To ensure that as many relevant studies are incorporated as possible, free terms such as prenatal, postnatal, perinatal and gestation were also used. Intervention studies and related cases published by July 1st, 2023, were also searched.

RESULTS

Twenty-one articles (including 3,901 mothers) were included in this review. Evidence showed that typical psychological interventions exhibited great effect, and family support programs, peer support, online yoga, and music therapy were also effective in reducing risk and improving the psychological well-being of the studied population.

CONCLUSION

Fetal abnormalities, miscarriage, premature birth, infants with low birth weights, hypertension, pre-eclampsia, HELLP syndrome, and hyperemesis gravidarum are associated with an increased risk of PTSD. Moreover, high-risk pregnant women may benefit from psychological interventions such as cognitive behavioral therapy (CBT). It may also be feasible and well-accepted for music therapy and exposure therapy to lessen the intensity of PTSD in mothers.

Posttraumatic stress disorder prevalence and childbirth: update meta-analysis after the introduction of the DSM-5 and COVID-19 pandemic

PURPOSE

Meta-analyses were previously performed to estimate PTSD prevalence in the postpartum period. Significant events that could impact this outcome occurred in the last decade, such as the publication of the DSM-5 in 2013 and the COVID-19 pandemic in 2020. This systematic literature review with a meta-analysis addressed studies published after 2014 to estimate PTSD prevalence after childbirth.

METHOD

The methodological guidelines recommended by PRISMA were followed. The meta-analysis estimate was the proportion of PTSD cases. The restricted maximum likelihood (REML) was the method adopted for estimation in addition to multilevel random effect models. Subgroup analyses were performed to assess the impact of interest variables.

RESULTS

The estimated prevalence was 0.10 (95%CI: 0.8-0.13; I2 = 98.5%). No significant differences were found regarding the introduction of the DSM-5 (p = 0.73) or COVID-19 (p = 0.97), but instead, between low- and middle-income countries, e.g., the Middle East presents a higher prevalence (p < 0.01) than European countries.

CONCLUSIONS

There is a potential increase in PTSD prevalence rates after childbirth in the last decade not associated with the pandemic or the current diagnostic classification. Most studies showed a methodological fragility that must be overcome to understand this phenomenon better and support preventive actions and treatment for puerperal women.

Effect of spiritual care education on the spiritual health of preeclamptic women with postpartum stress disorder

BACKGROUND

Spiritual health in the field of health has a great importance in mental disorders and posttraumatic stress disorders, in treatment process. The present study was done aiming "determine the effect of spiritual care education on the spiritual health of preeclamptic women with postpartum stress disorder."

MATERIALS AND METHODS

This randomized clinical trial was done in 2017 on 260 women with preeclampsia in Mashhad. Data collection was done with questionnaires Perinatal Posttraumatic Stress Questionnaire (PPQ), the posttraumatic disorder checklist, Duke University Religion Index, and the Spiritual Well-Being Scale (SWBS). In the intervention group, first, women were educated on spiritual care each day based on Richards and Bergin's pattern, in three sessions, which lasted 45-60 min. The control group also received routine cares. All units completed the questionnaire SWBS at the 8^th postpartum period. P < 0.05 was meaningful.

RESULTS

After the intervention, this score of spiritual health in the intervention and control groups had a significant difference with independent test (P = 0.004). Spiritual health significantly increased in the interventional group.

CONCLUSIONS

Providing spiritual care to pregnant mothers with preeclampsia, increase their spiritual health.

Effects of a psychological nursing intervention on prevention of anxiety and depression in the postpartum period: a randomized controlled trial

BACKGROUND

Anxiety and postpartum depression are the most common psychological problems in women after delivery. Cognitive behavior intervention has been reported to have an effect in the therapy of postpartum depression. This research aimed to investigate whether cognitive behavior intervention could prevent the pathogenesis of postpartum depression in primiparous women.

METHODS

In this randomized controlled trial, primiparous women who were prone to postpartum depression were recruited. Participates in the control group received routine postpartum care and those in the intervention group received both routine postpartum care and cognitive behavior intervention. Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), Edinburgh Postpartum Depression Scale (EPDS) and Pittsburgh Sleep Quality Index (PSQI) were evaluated before and after the intervention.

RESULTS

In the intervention group, the post-intervention scores of HAMA, HAMD, EPDS and PSQI were all significantly lower than the baseline scores (p = 0.034, p = 0.038, p = 0.004, p = 0.014, respectively). The proportion of participants with postpartum depression in the intervention group (11.5%) was significantly lower than the control group (24.3%) after the 6-week intervention. Participants in the intervention group were significantly more satisfied with the care than those in the control group (p = 0.032).

CONCLUSION

This research provided evidence that cognitive behavioral intervention in postpartum period could alleviate anxiety and depression in primiparous women, and inhibit the pathogenesis of postpartum depression. Trial registry This clinical trial was registered in the Chinese Clinical Trial Registry (ChiCTR2000040076).

Postpartum post-traumatic stress disorder: Associated perinatal factors and quality of life

BACKGROUND

The relationship between obstetric variables and postpartum post-traumatic stress disorder (PTSD), and its influence on quality of life (QoL), have scarcely been studied.

OBJECTIVE

Determine the prevalence of PTSD at postpartum weeks 4 and 6, and its relation with perinatal variables and quality of life METHOD: A cross-sectional study with 2990 Spanish puerperal women in Spain. Data were collected on socio-demographic and obstetric variables, and on newborns. An online ad hoc questionnaire was used, including the Perinatal Post-traumatic Stress Disorder Questionnaire (PPQ) and SF-36. The crude and adjusted odds ratios were estimated by binary logistic regression.

RESULTS

10.6% (318) of the women appeared at risk for PTSD symptoms. Factors like having a respected birth plan (aOR: 0.52; 95%CI: 0.34, 0.80), using epidural analgesia (aOR: 0.64; 95%CI: 0.44, 0.92) and performing skin-to-skin contact (aOR: 0.37; 95%CI: 0.28, 0.50) were protective factors against PTSD, among others. Instrumental birth (aOR: 2.50; 95%CI: 1.70, 3.69) and caesarean section (aOR: 3.79; 95%CI: 2.43, 5.92) were found to be risk factors, among others. The area under the ROC curve in this model was 0.79 (95%CI: 0.76, 0.81). The women with PTSD presented a mean difference for QoL of -13.37 points less than those without PTSD (95%CI: -11.08, -15.65).

CONCLUSIONS

The women with PTSD symptoms had a worse quality of life at postpartum weeks 4-6. Birth type, analgesia methods and humanising practices, like skin-to-skin contact and using respected birth plans, were related with presence of the postpartum PTSD risk.

Synthesis of Mixed Research on Posttraumatic Stress Related to Traumatic Birth

OBJECTIVE

To synthesize mixed-research results (quantitative and qualitative) on posttraumatic stress in women who experienced traumatic births.

DATA SOURCES

PubMed, Scopus, and PsycINFO databases.

STUDY SELECTION

Quantitative and qualitative studies were included if they were published in English from January 1, 2009, through December 31, 2018, and focused on posttraumatic stress in the postpartum period related to traumatic childbirth.

DATA EXTRACTION

The final sample consisted of 59 studies: 4 qualitative and 55 quantitative. Both authors independently appraised each study using the Critical Appraisal Skills Programme. Quantitative studies were synthesized by narrative synthesis and vote counting, and qualitative studies were synthesized by content analysis.

DATA SYNTHESIS

In the included studies, prevalence rates of elevated posttraumatic stress ranged from 0.8% to 26%. Significant predictors of posttraumatic stress that occurred before childbirth and those that were birth related were identified. Reports of six intervention studies to decrease posttraumatic stress symptoms after traumatic births were included. These interventions focused on postnatal debriefing, expressive writing, online cognitive behavioral therapy, a brief cognitive intervention, and the implementation of the nine instinctive stages of the infant during the first hour after birth. We created four themes from the findings of the qualitative studies: Distressing Symptoms, Detrimental Effect of Posttraumatic Stress on Women's Relationships With Their Infants and Partners, Critical Influence ofSupport, and Debriefing.

CONCLUSION

When a woman experiences posttraumatic stress related to a traumatic birth, the entire family unit is vulnerable. Findings from quantitative predictor studies can be used to develop an instrument to screen women for risk factors for posttraumatic stress related to birth trauma. Primary interventions are needed to prevent women from experiencing traumatic births.

Associations between postpartum depression and hypertensive disorders of pregnancy

OBJECTIVE

To identify possible relationships between postpartum depression and hypertensive disorders of pregnancy (HDP), as well as the associated risk factors for developing postpartum depression.

METHODS

The present prospective descriptive cross-sectional study was conducted among postpartum women who attended a public maternity hospital in Brazil between January 15, 2015, and January 15, 2017. The diagnosis and severity of HDP were based on blood pressure measurements (systolic ≥140 mm Hg or diastolic ≥90 mm Hg), proteinuria, clinical findings, and laboratory findings. A group of normotensive women was also included. The Edinburgh Postnatal Depression Scale was used to assess the risk of postpartum depression.

RESULTS

Of 168 participants (42 with HDP and 126 normotensive), 40 (23.8%) women displayed depressive symptoms (25 normotensive and 15 with HDP). The probability of postpartum depression correlated with a diagnosis of HDP (Spearman correlation coefficient [r_S ] 0.219; P=0.004); premonitory signs of eclampsia (r_S 0.171; P=0.027); magnesium sulfate therapy (r_S 0.199; P=0.010); diastolic blood pressure (r_S 0.165; P=0.033); and use of milk formula during hospitalization (r_S 0.152; P=0.048).

CONCLUSION

Women diagnosed with HDP were more likely to have depressive symptoms than their normotensive counterparts.

Patterns of Posttraumatic Stress Disorder Symptoms and Posttraumatic Growth in an Epidemiological Sample of Chinese Earthquake Survivors: A Latent Profile Analysis

Background: Posttraumatic stress disorder (PTSD) and posttraumatic growth (PTG) are different psychological outcomes triggered by exposure to extraordinarily traumatic events. In this study, we aimed to examine patterns of co-occurrence between DSM-5 PTSD symptoms and PTG, among natural disaster survivors, and to clarify whether empirically-based subgroups differed by several specific predictors. Methods: Latent profile analysis was used to examine patterns of self-reported PTSD symptoms and PTG in an epidemiological sample of 1063 Chinese earthquake survivors. Results: Three distinct profiles were identified, involving high PTSD/high PTG, mild PTSD/mild PTG, and mild PTSD/high PTG. Class membership was predicted by several variables, especially different sources of perceived social support. Conclusion: Our findings contribute to the knowledge about the coexisting patterns of PTSD and PTG, and provide suggestions for identifying high-risk individuals and providing effective interventions in clinical practice.

The prevalence of posttraumatic stress disorder during pregnancy and postpartum period

Introduction and Objective:

The majority of formerly conducted studies have focused on the prevalence of posttraumatic stress disorder merely during pregnancy period; however, pregnancy period is by itself accompanied with the stress of getting pregnant again; therefore, the present study was conducted to evaluate the prevalence of posttraumatic stress disorder (PTSD) during pregnancy and postpartum period.

Methods:

A total of 3475 articles were found by searching keywords of PTSD, pregnancy, stress, and birth, through various research databases, including PubMed, Google Scholar, and Science Direct; 37 papers turned out to be completely relevant, 18 of which had provided through examination of the prevalence of intended disorder.

Results:

The prevalence rate varied from 0% to 21% in community-related samples; this rate varied from 0% to 43% in high-risk samples.

Conclusion:

PTSD is a common phenomenon during pregnancy and postpartum period, and it might get worse and worse unless it is diagnosed and treated after delivery. Thus, it is recommended to assess pregnancy and postpartum services.

The prevalence of posttraumatic stress disorder in pregnancy and after birth: A systematic review and meta-analysis

BACKGROUND

Previous reviews have provided preliminary insights into risk factors and possible prevalence of Post-traumatic Stress Disorder (PTSD) postpartum with no attempt to examine prenatal PTSD. This study aimed to assess the prevalence of PTSD during pregnancy and after birth, and the course of PTSD over this time.

METHODS

PsychINFO, PubMed, Scopus and Web of Science were searched using PTSD terms crossed with perinatal terms. Studies were included if they reported the prevalence of PTSD during pregnancy or after birth using a diagnostic measure.

RESULTS

59 studies (N =24267) met inclusion criteria: 35 studies of prenatal PTSD and 28 studies of postpartum PTSD (where 4 studies provided prevalence of PTSD in pregnancy and postpartum). In community samples the mean prevalence of prenatal PTSD was 3.3% (95%, CI 2.44-4.54). The majority of postpartum studies measured PTSD in relation to childbirth with a mean prevalence of 4.0% (95%, CI 2.77-5.71) in community samples. Women in high-risk groups were at more risk of PTSD with a mean prevalence of 18.95% (95%, CI 10.62-31.43) in pregnancy and 18.5% (95%, CI 10.6-30.38) after birth. Using clinical interviews was associated with lower prevalence rates in pregnancy and higher prevalence rates postpartum.

LIMITATIONS

Limitations include use of stringent diagnostic criteria, wide variability of PTSD rates, and inadequacy of studies on prenatal PTSD measured in three trimesters.

CONCLUSIONS

PTSD is prevalent during pregnancy and after birth and may increase postpartum if not identified and treated. Assessment and treatment in maternity services is recommended.